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Cirrhosis

Topic Overview

What is cirrhosis?

Cirrhosis (say "suh-ROH-sus")
is a very serious condition in which scarring damages the
liver. The liver is a large organ that is part of the
digestive system. It does a wide range of complex jobs that are vital for life.
For example, the liver:

Makes many important substances, including
bile to help digest food and
clotting factors to help stop bleeding.

Filters poisons from the blood.

Breaks down
(metabolizes) alcohol and many drugs.

Controls the amounts of sugar, protein, and fat in the
bloodstream.

Stores important vitamins and minerals, including
iron.

When a person has cirrhosis, scar tissue (fibrosis) replaces healthy tissue. This scar tissue prevents the
liver from working as it should. For example, the liver may stop producing
enough clotting factors, which can lead to bleeding and bruising. Bile and
poisons may build up in the blood. Scarring can also cause high blood pressure
in the vein that carries blood from the intestines through the liver (portal hypertension). This can lead to severe bleeding
in the digestive tract and other serious problems.

Cirrhosis can
be deadly. But early treatment can help stop damage to the liver.

Swelling from fluid buildup in the legs (edema) and the
abdomen (ascites).

Bleeding from enlarged veins in the digestive
tract.

Confusion.

How is cirrhosis diagnosed?

The doctor will start
with a physical exam and questions about your symptoms and past health. If the
doctor suspects cirrhosis, you may have blood tests and imaging tests, such as
an
ultrasound or
CT scan. These tests can help your doctor find out
what is causing the liver damage and how severe it is.

To confirm
that you have cirrhosis, the doctor may do a
liver biopsy. This means that he or she will use a needle
to take a sample of liver tissue for testing.

How is it treated?

Treatment may include
medicines, surgery, or other options, depending on the cause of your cirrhosis
and what problems it is causing. It is important to get treated
for cirrhosis as soon as possible. Treatment cannot cure cirrhosis. But it can
sometimes prevent or delay further liver damage.

There are things you can do to
help limit the damage to your liver and control the symptoms:

Do not drink any alcohol. If you don't stop
completely, liver damage may quickly get worse.

Talk to your
doctor before you take any medicines. This includes both
prescription and over-the-counter drugs, vitamins, supplements, and herbs.
Medicines that can hurt your liver include acetaminophen (such as Tylenol) and other pain medicines such as aspirin, ibuprofen (such as Advil or Motrin), and naproxen (Aleve).

Make sure that your
immunizations are up-to-date. You are at higher risk
for infections.

Follow a
low-sodium diet. This can help prevent fluid buildup,
a common problem in cirrhosis that can become life-threatening.

Symptoms may not appear until a problem is severe. So it's important to see your doctor for regular checkups and lab tests. You may
also need testing to check for possible problems such as enlarged veins in your digestive tract or liver cancer.

If cirrhosis becomes life-threatening, then
a liver transplant may be an option. But a transplant is
expensive, organs are hard to find, and it doesn't always work.

Palliative care is a kind of care for people who have serious illnesses. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit.

If your cirrhosis is getting worse, you may want to make
important end-of-life decisions, such as writing a
living will. It can be comforting to know that you
will get the type of care you want.

It can be hard to face having
cirrhosis. If you feel very sad or hopeless, be sure to tell your doctor. You
may be able to get counseling or other types of help. Think about joining a
support group. Talking with other people who have cirrhosis can be a big
help.

Complications of cirrhosis

Scar
tissue from cirrhosis may block the proper flow of blood from the intestines through the
liver. The scarring can lead to increased pressure in the veins that supply this area. This is called
portal hypertension. It can lead to
other complications, which may include:

Hepatopulmonary syndrome. Portal
hypertension can cause lung problems, such as
widening of the blood vessels in the lungs. This causes the blood to
move too swiftly through the lungs to pick up enough oxygen.

Hepatic hydrothorax. Fluid can
build up between the lungs and the chest (pleural effusion) and press on the
lungs.

Endoscopic retrograde cholangiopancreatogram (ERCP),
to look inside the tubes (bile ducts) that drain the liver, pancreas, and
gallbladder. ERCP may be done if your doctor thinks that a condition called primary
sclerosing cholangitis (PSC) might be leading to your liver problems.

Ammonia testing. This test looks for excess ammonia in the
blood, which can cause altered brain function (encephalopathy).

Treatment Overview

No treatment will cure cirrhosis or repair
scarring in the liver that has already occurred. But treatment can sometimes
prevent or delay further liver damage. Treatment involves lifestyle changes, medicines, and regular doctor visits. In some cases, you may need surgery for treatment of complications from cirrhosis.

Lifestyle changes

Your doctor will recommend some lifestyle changes to help prevent further liver damage.

Stop drinking alcohol. You need to quit
completely.

Talk to your doctor about all of the medicines you take,
including nonprescription drugs such as acetaminophen (for example, Tylenol), aspirin, ibuprofen (for example, Advil or
Motrin), and naproxen (Aleve). These could increase the risk of liver damage and bleeding.

Balloon
tamponade. A
doctor inserts and inflates a balloon in the lower part of the esophagus or upper part of the stomach. This stops bleeding by pressing against the veins.

Changes in mental function.Encephalopathy may
occur when the liver cannot filter poisons from the bloodstream. As these toxins build
up in your blood, they can affect your brain function. You may need to:

Eat a limited amount of protein. Too much protein can cause toxins to build up.

Take
lactulose. This medicine helps prevent the buildup
of ammonia and other toxins in the large intestine.

Avoid sedative medicines, such as sleeping pills,
antianxiety medicines, and narcotics. These can make symptoms of encephalopathy
worse.

Follow-up visits

It's important to work with your doctor to watch your condition, especially because symptoms may not start until a problem has
become severe. In addition to regular checkups and lab tests,
you will also need periodic screening for enlarged veins (varices) and liver cancer
(hepatocellular carcinoma).

The American College of Gastroenterology
recommends testing for varices with endoscopy for all people who have
been diagnosed with cirrhosis. If your initial test does not find any varices, you can be
tested again in 2 to 3 years. If you already have large varices, you may need
more frequent testing and treatment with beta-blocker medicines to try to
prevent future bleeding episodes.footnote 1

Testing to check for liver cancer usually takes place every 6
months. You will likely have a test for alpha-fetoprotein
and a liver ultrasound or a magnetic resonance imaging test (MRI).

Liver transplant

Receiving a liver from an organ donor (liver transplant) is the only
treatment that will restore normal liver function and cure
portal hypertension. A liver transplant is usually
considered only when liver damage is severe and threatening your life.

Before your
condition becomes severe, you may want to talk to your doctor about whether you will be a good candidate for a
liver transplant if your disease becomes advanced.

Liver transplant surgery is
very expensive. You may have to wait a long time for a transplant, because so
few organs are available. Even if a transplant occurs, it may not work. With these things in mind, doctors must decide who will benefit
most from receiving a liver. Good candidates include those who have not abused alcohol or illegal drugs
for the previous 6 months and those who have a good support system of family and friends.

Talk to your doctor about what steps you
can take now to improve your overall health so that you can increase your
chances of being considered a good candidate.

Palliative care

Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit.
You can have this care along with treatment to cure your illness.

Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.

End-of-life care

A time may come when treatment for your illness no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.

Home Treatment

Lifestyle changes may reduce symptoms
caused by complications of the disease and may slow new
liver damage.

Giving up alcohol

If you are
diagnosed with cirrhosis, it is extremely important that you stop drinking
alcohol completely, even if alcohol was not the cause of your cirrhosis. If you
don't stop, liver damage may quickly become worse. For information about how
to quit drinking, see
Alcohol Abuse and Dependence.

Changing your diet

You may need to limit the amount of salt or protein you
eat.

If your body is retaining fluid, the most important
dietary change you need to make is to reduce your sodium intake. You do this by reducing the
amount of salt in your diet. People with liver damage tend to retain sodium. This can make fluid build up in your belly (ascites).

If you are at risk for altered mental function (encephalopathy) because of advanced liver disease,
your doctor may want you to limit the amount of protein you eat for a while.
You will still need protein in your diet to be well nourished. But you may need
to get most of your protein from vegetable sources (rather than animal sources).
And you may need to avoid eating large amounts of protein at one time.

Avoiding harmful medicines

Some medicines should
be used carefully or not taken by people who have cirrhosis. For example,
acetaminophen (such as Tylenol) can speed up liver damage.
Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)—for example, ibuprofen (such as Motrin or Advil) and naproxen (Aleve)—increase the risk of
variceal bleeding if you have enlarged veins (varices)
in the digestive tract. NSAIDs can also raise your risk for ascites. Talk to your doctor or pharmacist about what medicines
are safe for you.

Certain prescription medicines used to treat
other conditions may be harmful if you have cirrhosis. Make sure your doctor
knows all the medicines (including all nonprescription medicines, vitamins, herbs, and supplements) that you are taking.

Improving your general health

Taking other steps
to improve your overall health may help you cope with the symptoms of
cirrhosis.

Stop smoking. Quitting tobacco use will
improve your overall health, which may help make you a better candidate for a
liver transplant if you need one.

Your doctor may encourage you to
take a multivitamin. Don't take one containing extra iron unless your doctor
tells you to. And don't take an iron supplement unless your doctor recommends it.

Brush and floss
your teeth daily to avoid dental problems that could lead to infection (abscess). Be gentle when you floss so you don't make
your gums bleed.

Make sure you have been vaccinated against:

Influenza (flu). Get a flu shot every year. People with cirrhosis are at increased
risk for serious complications from the flu.

Pneumococcus(What is a PDF document?),
which can cause pneumonia or abdominal infection (peritonitis).
Ask your doctor how often you should be revaccinated.

Using complementary and alternative medicines wisely

In general, you should avoid most herbal and other supplements, which may
make liver disease worse.
Kava is particularly bad for people who have liver
problems.

Limited research has shown that the herbal supplement
milk thistle may help protect the liver, but other research has not shown a
benefit.footnote 2 Milk thistle will not reverse existing liver
damage, and it will not cure infection with the hepatitis B or hepatitis C
virus. Milk thistle should not be used by people who have complications from cirrhosis (such as variceal bleeding or ascites). Talk to your doctor about whether you should try milk thistle (or any
other alternative treatment).

Other Places To Get Help

Organizations

American Liver Foundation (ALF)

www.liverfoundation.org

National Institute of Diabetes and Digestive and Kidney Diseases (U.S.)

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